Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis

Hidekatsu Kuroda; Yudai Fujiwara; Tamami Abe; Tomoaki Nagasawa; Takuma Oguri; Sachiyo Noguchi; Naohisa Kamiyama; Yasuhiro Takikawa

doi:10.1371/journal.pone.0249493

Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis

PLoS One. 2021 Apr 7;16(4):e0249493. doi: 10.1371/journal.pone.0249493. eCollection 2021.

Authors

Hidekatsu Kuroda¹, Yudai Fujiwara¹, Tamami Abe¹, Tomoaki Nagasawa¹, Takuma Oguri², Sachiyo Noguchi², Naohisa Kamiyama², Yasuhiro Takikawa¹

Affiliations

¹ Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
² Ultrasound General Imaging, GE Healthcare, Hino, Tokyo, Japan.

Abstract

Background and aims: We investigated the usefulness of combining two-dimensional shear wave elastography and the ultrasound-guided attenuation parameter for assessing the risk of progressive non-alcoholic steatohepatitis, defined as non-alcoholic steatohepatitis with a non-alcoholic fatty liver disease activity score of ≥4 and a fibrosis stage of ≥2.

Methods: This prospective study included 202 patients with non-alcoholic fatty liver disease who underwent two-dimensional shear wave elastography, ultrasound-guided attenuation parameter, vibration-controlled transient elastography, the controlled attenuation parameter, and liver biopsy on the same day. Patients were grouped according to liver stiffness measurement using two-dimensional shear wave elastography and the attenuation coefficient, assessed using the ultrasound-guided attenuation parameter: A, low liver stiffness measurement/low attenuation coefficient; B, low liver stiffness measurement/high attenuation coefficient; C, high liver stiffness measurement/low attenuation coefficient; and D, high liver stiffness measurement/high attenuation coefficient.

Results: Two-dimensional shear wave elastography and vibration-controlled transient elastography had equivalent diagnostic performance for fibrosis. The areas under the curve of the ultrasound-guided attenuation parameter for identifying steatosis grades ≥S1, ≥S2, and S3 were 0.89, 0.91, and 0.92, respectively, which were significantly better than those of the controlled attenuation parameter (P<0.05). The percentages of progressive non-alcoholic steatohepatitis in Groups A, B, C, and D were 0.0%, 7.7%, 35.7%, and 50.0%, respectively (P<0.001). The prediction model was established as logit (p) = 0.5414 × liver stiffness measurement (kPa) + 7.791 × attenuation coefficient (dB/cm/MHz)-8.401, with area under the receiver operating characteristic curve, sensitivity, and specificity values of 0.832, 80.9%, and 74.6%, respectively; there was no significant difference from the FibroScan-aspartate aminotransferase score.

Conclusion: Combined assessment by two-dimensional shear wave elastography and the ultrasound-guided attenuation parameter is useful for risk stratification of progressive non-alcoholic steatohepatitis and may be convenient for evaluating the necessity of specialist referral and liver biopsy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Disease Progression*
Elasticity Imaging Techniques*
Female
Humans
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / diagnostic imaging*
Non-alcoholic Fatty Liver Disease / pathology
Ultrasonography

Grants and funding

This work was supported by JSPS KAKENHI [grant number JP 19K08400]. T.O., S.N. and N.K. are paid employees of GE Healthcare Japan. The funder provided support in the form of salaries for authors [H.K.]. However, it did not have any additional role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.